Nutritional Status

( )  The physiological state of an individual, which

A. Nutrition Care Process (ADIME Process)
1. Nutritional History
2. Dietary Intake Data
3. Nutrient Intake Analysis (NIA)
4. Food Diary
5. Food Frequency
6. 24-Recall
B. Physical Assessment
Anthropometric Measurements
1. Height and Weight
2. BMI
3. Body Composition
4. Mid-arm circumference (MAC)
5. Fat-fold or Skin-fold thickness
 Systematic process of obtaining, verifying, and
interpreting data in order to make decisions
about the nature and cause of nutrition-related
problems
 Nutrition Care Process Model (NCPM) describes
the NSP by presenting the workflow of
professionals in diverse individual and population
care delivery settings. It illustrates the steps of
the Nutrition Care Process as well as internal and
external factors that impact application of the
NCP
results from the relationship between nutrient
intake and requirements and from the body’s
ability to digest, absorb and use these nutrients
 Degree to which physiologic nutrient needs are
met for an individual
Nutritional Assessment
How do we measure nutritional status?
 Anthropometric measurements
- height and weight
 Biochemical parameters
- laboratory tests for nutrients or related
components such as pre albumin, iron, and
vitamin B12
 Clinical evaluation
 Dietary history
What is the purpose of the nutritional
assessment?
 To define patient’s nutritional status;
malnourished, well nourished, underweight,
overweight, obese
 To make a diagnosis based on nutritional status
 To start developing a nutritional care plan
(treatment needed)
 To determine when to screen for disease
 To establish the adequacy of diet
 To monitor changes in nutritional status over
time: hospital, long-term facility, periodic
ambulatory clinic visits
Nutritional History
1. Dietary intake
 Can be assessed by subjective report and
objective observation
 Subjective Assessment  It can help you realize what you consume
 Once you know this, you can make changes
 Possible using open-ended surveys such
to your diet to improve your weight
as dietary recalls or records, or records,
or using closed-ended surveys
Objective Observation
 Eating behaviors including items and
amounts of foods consumed, received or
given away, or spilled can all be noted
Sample of Diet History Form
4. food frequency
 To assess habitual diet by asking about the
frequency with which food items or specific
food groups are consumed over a reference
period
 This method can be used to gather
information on a wide range of foods or can
be designed to be shorter and focus on
foods rich in a specific nutrient or on a
particular group of foods e.g. fruit and
vegetables

2. Nutrient intake analysis (nIA)

 Tool used in various inpatient settings to
identify nutritional inadequacies by monitoring
intakes before deficiencies develop
 Information about actual intake is collected
through direct observation or an inventory of
foods eaten based on observation of what
remains on the individual’s tray or plate after
meal
3. Food diary
 Daily log of what you eat and drink each day
 It helps you and your doctor understand your
eating habits
5. 24-recall 1. Height/length and weight for children
 24-hour dietary call (24HR) is a structured
interview intended to capture detailed  Used for children under two years
information about all foods and beverages  Wooden measuring board is used
(dietary supplements) consumed by the
respondent in the past 24 hours, most  Used for children who are two years old or
commonly, from midnight to midnight the more and adult in standing position
previous day
24-hour recall sample template  Salter scale and spring balance is used for
measuring the weight of children under two
Meal Food Item Quantity Calories years’ old
Breakfast Rice 1 cup 200kcal
 Beam balance is used in adults and children
Canned Tuna 100 grams 100kcal
over two years
(afritada)
A.M. White bread 2 slices 148kcal  In both cases, a digital electronic scale can be
Snack with cheese used if you have one available
Spread 2 tbsp 236kcal
Lunch Rice 1 cup 200kcal
Galunggog 1 piece 41 kcal To measure the length of a child under two years, you
Ginataang 1 cup 220kcal need one assistant and a sliding board
sitaw at
kalabasa 1. Both assistant and measurer are on their knees
P.M. Mamon 1 piece 160kcal 2. The assistant holds the child’s head with both
Snack hands and makes sure that the head touches
Dinner Rice 1 cup 200kcal the base of the board
Adobong pork 1 cup 200kcal 3. The assistant’s arms should be comfortable
Total 1705kcal straight
4. The line of sight of the child should be
perpendicular to the base of the board
Physical Assessment
5. The child should lie flat on the board
Anthropometric measurement 6. The measurer should place their hands on the
 Measurement of physical dimensions such as child’s knees or shins
height or weight, as well as the fat mass 7. The child’s foot should be flat against the foot
composition of the human body to provide piece
information about a person’s nutritional status 8. Read the length from the tape attached to the
 To assess growth in children you can use several board
different measurements including length, height, 9. Record the measurement
weight, and head circumference
Wooden measuring board
As with measuring a child’s length, to measure a child’s
height, you need to have another person helping you
The head should be in the Frankfurt position (a position
where the line passing from the external ear hole to the
lower eye lid is parallel to the floor) during measurement,
and the shoulders, buttocks and the heels should touch
the vertical stand. Either a stadiometer or a portable
anthropometer can be used for measuring.
Measurements are recorded to the nearest millimeter.
1. Both the assistant and measurer should be on
their knees
2. The right hand of the assistant should be on the
shins of the child against the base of the board
3. The left hand of the assistant should be on the
knees of the child to keep them close to the
board
4. The heel, calf, buttocks, shoulder and occipital
prominence (prominent area on the back of the
head) should be flat against board
5. The child should be looking straight ahead
6. The hands of the child should be by their side
7. The measurer’s left hand should be on the child’s
chin
8. The child’s shoulders should be levelled
9. The head piece should be placed firmly on the
child’s head
10. The measurement should be recorded on the
questionnaire
 decreased mental and physical productivity
capacity
3. Weight-for-height
1. Adjust the pointer of the scale to zero level  An index used for assessing wasting (acute
2. Take off the child’s heavy clothes and shoes malnutrition)
3. Hold the child’s legs through the leg holes  Wasting is defined as a low weight for the
4. Hold the child’s feet height of the child compared to the standard
5. Hang the child on the Salter Scale child of the same height. Wasted children are
6. Read the scale at eye level to the nearest 0.1 kg vulnerable to infection and stand a greater
7. Remove the child slowly and safely chance of dying
Birth weight
 Weight of the child at birth and is classified as
follows
More than 2500 grams Normal
1500-2499 grams Low
Less than 1500 grams Very Low

1. Weight-for-age
 An index used in growth monitoring for
assessing children who may be underweight
 You assess weight-for-age of all children
under two years old when you carry out
your community-based nutrition (CBN)
activities every month
2. Height-for-age
 Index used for assessing stunting (chronic
malnutrition in children)
 Stunted children have poor physical and
intellectual performance and lower work
output leading to lower productivity at
individual level and poor socioeconomic
development at the community level
 Stunting is defined as a low height for age of
the child compared to the standard child of
the same age. Stunted children have
  Body Mass Index (BMI), also known as
Quetelet’s index, is a simple index of weight-
for-height that is commonly used to classify
underweight, overweight, and obesity in
adults
 It is defined as the weight in kilograms
divided by the square of the height in meters
(kg/m2)
 It is a validated measure of nutritional status
 It accounts for differences in body
composition by defining the level of adiposity
according to the relationship of height and
weight, thus eliminating the dependence on
frame size
𝑊𝑒𝑖𝑔ℎ𝑡
 𝐵𝑀𝐼 = 𝐻𝑒𝑖𝑔ℎ𝑡 2
 For example, an adult who weighs 70kg and
whose height is 1.75m will have a BMI of
22.9
2. BMI 70𝑘𝑔
𝐵𝑀𝐼 =
(1.75𝑚)2
70𝑘𝑔
𝐵𝑀𝐼 =
(3.0625 𝑚)2
𝐵𝑀𝐼 = 22.9𝑘𝑔/𝑚2

Conversion of Height from feet and inches to

centimeters
Ideal Body Weight Based on Height Adults
Male Female
- 106 lbs for the first - 100 lbs for the first
five feet of height five feet of height
- An additional 6 lbs for - An additional 5 lbs for
every inch over five feet every inch over five feet
*** an adjustment is then made for a large frame
(+10%) and for the small frame (-10%)

Example:
1. Calculate the IBW of a woman with a height of 63
inches and a wrist circumference of 20 cm
2. 63 in = 5’3” = 100 ;bs for the first 5 feet
3. The remaining 3 inches x 5lbs
IBW = 100lbs + {(3in) (5lbs/in)}
= 100lbs + 15lbs
= 115lbs
4. Determine the frame size of the person using the
 ore useful parameter than ideal body weight
wrist circumference
for those who are ill
 Comparing their present weight to their 𝐻𝑒𝑖𝑔ℎ𝑡 𝑖𝑛 𝑐𝑚
𝑟=
usual body weight allows weight status 𝑤𝑟𝑖𝑠𝑡 𝑐𝑖𝑟𝑐𝑢𝑚𝑓𝑒𝑟𝑒𝑛𝑐𝑒 𝑖𝑛 𝑐𝑚
changes to be assessed
2.54 𝑐𝑚
 The only problem is that, UBW depends on (63 𝑖𝑛)( )
𝑟= 1𝑖𝑛
the patient’s memory 20𝑐𝑚
160.02 𝑐𝑚
 Weight measurement obtained at the time of 𝑟=
20 𝑐𝑚
the examination
 This measurement may be influenced by the = 8.001
individual’s fluid status Male (r) Female (r)
Small >10.4 >11
 It is the imprecise term used to describe Medium 9.6 – 10.4 10.1 – 11.0
optimal weight for optimal health Large < 9.6 <10.1
 This can be estimated using the Hamwi Based on the computed r, the person has a large frame
method or the Fernando’s method
5. Add 10% to the IBW
IBW for large frame = 115lbs + {(10%) (115lbs)}
= 115 lbs + 11.5 lbs.
= 126.5lbs
Infants Whole body
>> body mass, stature, size, volume, density
0-6 months
 IBW = birth weight in (g) + {(age in mos.)(600)}
7-12 months
 IBW = birth weight in (g) + {(age in mos)(500)}
Children
1-12 y/o
 IBW = (age in years + 8)

3. Body composition

 One of the anthropometric methods used

for measuring body fat is the skinfold test

 Underwater weighing calculates the total

body fat by the density of the body

4. Fat-fold or skin-fold thickness

 Describes the relative proportions of fat,
bone and muscles mass in the human body
 It can be described at 5 levels
Atomic
>> C,H,O,N
Molecular
>> protein, carbohydrates, lipids
Cellular
>> fat cells, body fluids, extracellular solids
Tissue
>> skeletal muscles, bone blood
 Skinfold measurements are generally taken
at specific sites on the right side of the body
 The tester pinches the skin at the location
site and pulls the fold of skin away from the
underlying muscle so only the skin and fat
tissue are being held
 Special skinfold calipers are then used to
measure the skinfold thickness in millimeters
The measurement sites vary depending upon the specific
skinfold testing protocol being used, but typically include
the following seven locations on the body
1. Triceps
>> back of the upper arm
2. Pectoral
>> mid-chest, just forward of the armpit
3. Subscapular
>> beneath the edge of the shoulder blade
4. Midaxilla
>> midline of the side of the torso
5. Abdomen
>> next to the belly button
6. Suprailiac
>> just above the iliac crest of the hip bone
7. Quadriceps
>> middle of the upper thigh

To calculate body fat percentage, add your waist and hip

measurements, and then subtract the neck
measurements to determine your circumference value
Example:
If your waist is 30, your hips are 36, and your neck is 13,
your circumference value would be 53
Body fat% = W + H –N
= 30 + 36 = 66 – 13 = 53
Body fat percentage ranges
Age 20-29 30-39 40-49 50-59 60+
Male 7-17 12- 14- 16- 17-
% 21% 23% 24% 25%
Female 16- 17- 19- 22- 22-
24% 25% 28% 31% 33%

Falling within these ranges is considered “ideal”

5. Mid-arm circumference (MAC)
Locate the midpoint of the arm:
 Non-dominant arm elbow flexed at 90
degrees with palm facing upwards
  Measurer stands behind the subject and
locates the lateral tip of the acromion and
the most distal point on the olecranon
process
 Place a tape measure so that it passes
between these 2 landmarks and mark the
midpoint
1. The subject stands erect with arms hanging
freely at the sides and the palms facing the
thighs
2. Place the tape measure perpendicular to the long
axis of the arm of the marked midpoint and
measure the circumference to the nearest mm
(e.g. 18.1 cm)
3. Provide the actual MAC in cm
1. Instruct the child to relax their left arm at their
side
2. Wrap the color-coded tape measure around the
child’s left arm
3. Loop the tape around their arm, running the
small tail end through the hole
4. Pull the tape snug against the child’s arm
5. Record the value that shows in the window
between the 2 arrows
1. Position the person’s left arm at a 90-degree
angle
2. Measure from their shoulder to their elbow to
find the midpoint
3. Measure their relaxed arm at the place where
you made the marking
4. Write down the measurement to the nearest
millimeter

 During 1-5 years of age it remains reasonably

static between 15-17 cm among healthy children
 It is conventionally measured over the left upper
arm, at a point marked midway between
acromion (shoulder) and olecranon (elbow) with
arm bent at right angle
 The child is asked to stand or sit with the arm
hanging loose at the side
 MUAC is measured with a fiber glass or steel
tape
 If it is less than 12.5 cm it is suggestive of
severe malnutrition
 If it is between 12.5-13.5 it is indicative of
moderate malnutrition